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t m c » p u l s e | j a n / f e b 2 0 1 6 16 16 opportunities in the form of preparation, the instruments are, as they say, only as good as their operators. Through a first-of-its-kind public health campaign, the fetal cardiology team at Children's Memorial Hermann Hospital has made it their personal mission to provide advanced training to sonographers throughout Harris County and beyond. Their goal is to teach these clinicians not only how to become profi- cient in the equipment itself, but to also recog- nize when the developing heart looks abnormal; if a sonographer suspects an anomaly, he or she will send the image to Memorial Hermann for evaluation and diagnosis—an elegant example of the telemedicine activities for which the hos- pital system is renowned. "A network approach is quite important," Gardiner explained. "We use several advances to support our network of clinicians who work more remotely from the cardiac surgical cen- ter. This begins by ensuring they have good ultrasound equipment and are familiar with the screening heart views, the five transverse views. We can then view these scans from hundreds of miles away using the Memorial Hermann System to address the sonographer's or physician's concerns, and we can determine whether or not the mom needs to travel here to see a specialist." Although ambitious in its breadth, the team does not expect to produce any overnight experts in the many variations of congenital heart disease. "It's important to us that the sonographers in the community know what to look for, not so much so they can make a diagnosis—that's not Historically, CHD was discovered in new- borns through a predictable litany of symptoms: labored breathing, weak pulse, poor feeding, excessive sleepiness or a bluish tint to the skin indicating that the blood is not receiving oxygen—a condition known as cyanosis or "blue baby." In recent years, however, prenatal screening for heart malformations has become routine, meaning a majority of these conditions are caught as many as 20 weeks before birth. It's a practice that is largely heralded as a central factor in the uptick of survival rates for babies born with CHD. Using a sophisticated imaging technique called fetal echocardiogram ultrasound, sonog- raphers are able to evaluate multiple views of high-quality images of a developing fetus' heart. If a problem is suspected, the mother is referred to a fetal cardiologist for diagnosis and management. "Getting a clearer look at the function of these babies' hearts enables us to improve risk stratification before birth," said Helena Gardiner, M.D., co-director of the Fetal Cardiology Program at The Fetal Center at Children's Memorial Hermann Hospital and McGovern Medical School at UTHealth. "The most serious heart conditions will require very careful management within the first hours after a baby is born, and for that reason we recommend that these patients be delivered in the medical center so that they can be close to the experts who specialize in this kind of care. Having a baby with a heart problem should not be a surprise." While this innovation has afforded lifesaving c a r diopu l mona ry by pa ss m achin e T he creation of the was crucial for the development of heart surgery for both adult and pediatric patients. The machine uses a pump and oxygenator to bypass the heart and lungs, allowing surgeons to stop the heart and operate on it without impairing circulation.